Provider Demographics
NPI:1902561798
Name:GRAYBILL, FREDERICK II
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:GRAYBILL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 GREENBAG RD STE A1
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-7123
Mailing Address - Country:US
Mailing Address - Phone:304-241-8401
Mailing Address - Fax:
Practice Address - Street 1:5000 GREENBAG RD STE A1
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7123
Practice Address - Country:US
Practice Address - Phone:304-241-8401
Practice Address - Fax:304-241-8402
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0-21-13067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst